25223 Xerox Corporation INDIANA RETAIL TAX EXEMPT PAGE
City ® �� ��+►� CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
D C ftk7 /47 I J 2 FEDERAL EXCISE TAX EXEMPT 5��3
��� /// (/V 35-60000972 i;
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
tl/i3/i .
SHIP
VENDOR 02
/6 PLC TO
CONFIRMATION BLANKET (CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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S A vpie S- 1/64°
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• 200000,0_ ,A0,4v
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''''1‘.141*Appb.N 1 4. *T.D.''"°°°°°..6° 0 000 Y
Send Invoice To: ri _ " '
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
M7 'Y30 .5;3 00 y PAYMENT A,3 ' . 3
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELU.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE /�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
25223. CLERK-TREASURER l/ F
DOCUMENT CONTROL NO. OFFICE COPY